Causes of sleep disturbances
- Changes in brain can cause restlessness and sleep disturbance.
- Physical health problems such as urine infections or prostate problems .
- Pain or discomfort, such as arthritis.
- Reduced need for sleep as part of normal ageing or sleeping too much during the day.
- Nightmares and waking up with anxiety and confusion.
- Environmental factors such as noise or feeling too hot or cold.
During the day
Try to encourage the person with dementia to get adequate exercise during the day. Generally trying to keep fit helps.
Natural light aids the body’s natural day-night rhythm.
Try and ensure that he or she gets adequate natural light by spending some time outside or sat near a window. This is particularly important in the winter.
Providing adequate lighting (artificial or natural) throughout waking hours is also important.
During the evening
If possible encourage the person living with dementia to take some light exercise or activity early in the evening. Encourage him or her to wind down during the course of the evening. Try not to let them do anything that is mentally demanding within 90 minutes of bedtime.
Try to keep the topic of conversation lively and positive without dwelling on any problems that have occurred during the day. Reassure the person living with dementia that all is well and it is now time to relax.
Discourage sleeping or dozing in the armchair if possible. Try and keep sleep for bedtime.
Do not give the person living with dementia too much tea, coffee or other drinks containing caffeine. Only give them a light snack for supper.
Do not give them alcohol to drink to aid their sleep – it usually does the opposite.
If they are a smoker, try to discourage them from smoking during the evening and doing so just before bed.
Consider whether medication might be causing sleep problems – dementia medication can cause night-time stimulation or disturbed sleep. Consider taking the medication in the morning or earlier in the day. If you are unsure, ask advice from his or her pharmacist or doctor.
Try to establish a regular routine - use regular bedtime ‘cues’ such as the 10 o’clock news, turning-off some lights to signal bedtime or by using familiar routines.
If you need to, explain in a clear and calm manner that it is bedtime, for example, “It’s 10 o’clock now – it’s time to put your pyjamas on”. If you need to, follow-up on what you are saying by showing the person what to do at each stage, e.g., show them their pyjamas to put on, and so on.
Try to encourage the person to go to bed at a regular time or when they show signs of tiredness but discourage them from starting to go to bed earlier and earlier in the evening.
Make sure the bed and bedroom are comfortable – not too cold and not too warm.
Discourage reading or watching TV in bed. Keep these activities for another room.
Put the main lights out when the person living with dementia gets into bed. Use a dim nightlight to help the person find their way to the bathroom or find their way around.
Try playing soft music as the person goes to sleep
Set the morning alarm for the same time every day, seven days a week, at least until their sleep pattern settles down.
If they have problems getting to sleep
If the person continues to refuse to go to sleep at a reasonable time then try to be flexible – make sure the house is safe if they walk around at night or let them sleep on the sofa. Let them carry-out any rituals that they need to in order to calm down.
It may help the person to recognise that it is bedtime if you wear night-clothes yourself, even if you are not ready for bed, as this acts as another ‘cue’ for bedtime.
Remember that sleep problems are quite common and they are not as damaging as you might think. Try not to let yourself or the person living with dementia get upset or frustrated.
You may decide to sleep in separate beds or rooms so that you can get a well-deserved good night’s sleep.
Have realistic expectations about the person’s sleeping pattern; people with dementia often have disturbed sleep but may get enough sleep over a 24 hour period.
A good sleep pattern may take a number of weeks to establish.